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Sunday, 11 August 2013

Increasing Hysterectomy for quick money.................87213

“Although
hysterectomy is one of the most common operations in gynaecological
departments, it has recently been surrounded by controversies after
there were reports from several States regarding needless hysterectomies
being conducted on women in abnormally large numbers giving it all a
projection of mass hysterectomies conducted by private medical
practitioners in a spree to make more money,” says Chhaya Pachauli, a
health activist with Chittoor-based non-governmental organisation called
Prayas.

Experts suggest that doctors should resort to this operation only when all other treatment options fail.

A Right to Information Act (RTI) application filed in Dausa in
Rajasthan revealed that between April and October 2010, out of a total
of 385 operations reported by three private hospitals, 286 were
hysterectomies. Many of these women were under the age of 30, with the
youngest being 18.

.

.

.

When medical professionals, legal experts, health
activists, and the officials of the Ministry of Health and Family
Welfare meet here on Monday, on their agenda is a rather peculiar
subject — rising cases of hysterectomies in India.

Hysterectomy
is the complete or partial removal of the uterus, and sometimes
ovaries, cervix and fallopian tubes. Ethically, a doctor should suggest
this operation in case of certain medical conditions, or when all other
treatment options fail.

Most common

“Although
hysterectomy is one of the most common operations in gynaecological
departments, it has recently been surrounded by controversies after
there were reports from several States regarding needless hysterectomies
being conducted on women in abnormally large numbers giving it all a
projection of mass hysterectomies conducted by private medical
practitioners in a spree to make more money,” says Chhaya Pachauli, a
health activist with Chittoor-based non-governmental organisation called
Prayas.

However, experts believe that with advances
in medical science, the operation need not be a necessity. Women can opt
for oral remedies, hormonal injections, intra-uterine devices and
endometrial ablation to get rid of problems like heavy bleeding and
fibroids. Experts also suggest that doctors should resort to this
operation only when all other treatment options fail.

No exact statistics

While
there are no exact statistics to show the prevalence rate of these
operations in India, what is largely believed is that they are the
second most common surgeries performed on women, second only to
caesarean sections. They have become controversial lately because of an
unusually large number performed on young women. The rising concern is
not just about the high expenditure and medical ethics, but also about
the complications and troubles that follow. Hysterectomy may have a
significant impact on woman’s health.

A Right to
Information Act (RTI) application filed in Dausa in Rajasthan revealed
that between April and October 2010, out of a total of 385 operations
reported by three private hospitals, 286 were hysterectomies. Many of
these women were under the age of 30, with the youngest being 18.

Not informed

Reports
from Chhattisgarh and Bihar, too, highlighted the high number of
hysterectomies being performed there and also linking them to the
rollout of the Rashtriya Swasthya Bima Yojna (RSBY) insurance scheme.
What makes the procedures more attractive is that being covered by the
RSBY or other government sponsored insurance schemes, they are free.

“Women
are neither informed about its long-term consequences, nor the
alternative medical treatments available. Over 16,000 hysterectomies,
most of them “unnecessary,” have been reported at private hospitals
across Bihar during the last one year allegedly to “avail insurance
benefit under the RSBY,” Ms. Pachauli explained.

In
2010, the Andhra Pradesh government had to tweak its State-sponsored
insurance scheme to disallow hysterectomies in private hospitals after
surveys revealed that uteruses of a number of beneficiaries were removed
merely to claim higher insurance amounts.

“The
objective of the consultation is to have informed deliberations around
the issue in order to identify possible reasons which are driving large
number of young women to have hysterectomies in the country, examine
them through the lens of reproductive health rights and medical ethics
and if required create firm ground for further advocacy and partnerships
with different stakeholders to address the issue holistically,”
according to a spokesperson of the Health Watch Trust which is
organising the meeting.The issues to be taken up at the daylong
consultation include discussion on evidence on incidence, indications,
epidemiology, out-of-pocket expenditures on hysterectomy; role of
professional associations for management of common uterine disorders;
and the need for alternative/independent sources of information on
hysterectomies

Another crucial study on
hysterectomies was carried out to find out prevalence in a 2010
cross-sectional household survey of 2,214 rural and 1,641 urban, insured
and uninsured women in low-income households in Ahmedabad city and
district in Gujarat. The study, done by Sapna Desai, Tara Sinha, and
Ajay Mahal and published in Reproductive Health Matters, investigated
why hysterectomy was a leading reason for use of health insurance by
women insured by SEWA, a women’s organisation that operates a
community-based health insurance scheme. It was found that of insured
women, 9.8 per cent of rural women and 5.3 per cent of urban women had
had a hysterectomy, compared to 7.2 per cent and 4.0 per cent,
respectively, of uninsured women. Approximately one-third of all
hysterectomies were in women younger than 35. Rural women used the
private sector more often for hysterectomy, while urban use was almost
evenly split between the public and private sectors.

“The
whole issue has now come under the purview of various women’s health
rights advocates and what has raised eyebrows is the fact that many of
these hysterectomies could have been avoided and that women are not
given the whole story before they are taken for such life-altering
surgery. Health rights advocates have even gone to the extent of
regarding these incidents not just as a clear violation of reproductive
health rights but also as a heinous crime and a form of violence on
women,” Ms. Pachauli told
The Hindu
.

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